The 1-year-old Affordable Care Act will prove over time to be a “major benefit to Montanans and it will be appreciated,” but it will take time, said Sen. Max Baucus, as objections to the law continue to make state and national headlines.
Montana lawmakers have tried to repeal the law, Rep. Denny Rehberg always refers to it as “Obamacare,” and during a speech in Helena last month, Republican presidential hopeful Michelle Bachmann said a top priority for Republicans nationally is to repeal the federal health care overhaul.
But Consumers Union, the nonprofit organization that publishes Consumer Reports, said the law is “a bold move toward better access, affordability and reliability.”
The legislation established health insurance as a right and a responsibility for every American and is on pace to reduce the rate of health care costs for individuals and businesses, Baucus said.
So, why the criticism?
“They don’t understand it,” Baucus said in a telephone interview. “People are confused. People really don’t know what this bill does. Most of the benefits won’t accrue immediately. ... There’s a lot of misinformation about it.”
Baucus, a lead architect of the law, remains a supporter, despite his plummeting approval ratings. In a recent Gazette State Poll, Montanans gave Baucus a 38 percent job approval rating. His performance rating dropped from 67 percent in the last Gazette State Poll in May 2009, when he led the pack of politicians scored.
Polls by other groups also have shown Baucus’ job performance scores have dropped since his role in passage of the law.
Baucus called the results “interesting” but doesn’t waver in his support.
“It’s confusing,” Baucus said. “There’s just a lot here, and in the meantime, we need to keep working on it to make it better. It was appropriate legislation. It was the right thing to do. Of course, it’s not perfect and, of course, we’ll keep working on it to make it even better. We need to keep talking about it and keep listening.”
Polls show that one in eight people believe they have been helped by the law, long before it fully takes effect in 2014.
Struggle with cancer
Kim Wombolt, 52, of Laurel, has had bone marrow cancer for five years and has received two stem cell transplants. The first was $85,000; the second, $125,000.
Throughout her illness, she has been hospitalized at least 100 days. She remains in the care of physicians and fills eight prescriptions a month.
The Wombolts were quickly reaching — and fearful of surpassing — the $1 million cap on Wombolt’s husband, Leonard’s, insurance.
Kim contemplated leaving her husband of 34 years. She thought it was the only solution to keep the hospitals, physicians and bill collectors from seizing their assets once they maxed out their coverage. She also thought that as a single woman she might be eligible for Medicare.
“I didn’t think he deserved to lose everything he’s worked so hard for because I got sick,” Kim said.
On Jan. 1, the Affordable Care Act banned insurance companies from imposing lifetime dollar limits on health benefits.
“If it were not for health reform, I would most certainly die,” Kim said.
Kelli and Steve Carlson’s baby was born on May 21 — five weeks premature. Baby Rowan had respiratory distress and was treated for pneumonia. She was in neonatal intensive care for 21 days, accruing bills exceeding $85,000.
Though Kelli, 31, and Steve, 32, had insurance through her job at Colstrip Public Schools, they had not added their infant to their coverage within 31 days, and claims for her care were denied.
“At no point as she was fighting for her little life did I think, ‘Oh, I need to read our insurance booklet and enroll her in our insurance plan,’” Kelli said. “These insurance companies should not be allowed to treat us like that. It was probably the worst summer of my life, having the stress of all that looming over your head. I was scared we would have to sell the house.”
Because of a provision in the Affordable Care Act, the Montana Insurance Commissioner’s office intervened, enrolled Rowan and got the insurance company to pay.
John Tooke, a certified public accountant in Miles City, employs two people. When President Barack Obama signed the Affordable Care Act, small businesses became eligible for tax credits up to 35 percent of their premium contributions for employee coverage, making insurance more affordable.
Tooke said offering employees health care is one of biggest benefits employers can offer, yet he knows many small businesses that have been forced to drop it because of cost.
“Hopefully there will be a much wider array of businesses offering health care insurance because the costs will be mitigated,” Tooke said. “It hasn’t directly helped me yet because I haven’t taken full advantage of it in my office, but it will. This whole issue is the first shot across the bow. Yes, there are some things that need to be fixed ... but at least now we’re talking and arguing about it.”
By 2014, small businesses with up to 100 employees will have access to state-based Small Business Health Options Program exchanges, where they may purchase affordable, quality insurance and may qualify for tax credits up to 50 percent of employer premium contributions.
Patients at ‘high risk’
Sue Bailey of Billings said her family has benefited from the law.
Bailey’s 27-year-old daughter, whose employer does not provide health insurance for part-time workers, has been able to secure health coverage from the expanded “high-risk” insurance pool from Montana Comprehensive Health Association using money provided by the Affordable Care Act.
Bailey said her family no longer will face the possibility of losing its health insurance because they have maxed out their “lifetime limits.”
Reform under fire
One of the biggest misconceptions about the bill, Baucus said, is that it is costing taxpayers money when they can least afford it.
“This bill does not cost one thin dime,” Baucus said. “It’s all paid for. It does not put additional burden on Montana businesses or taxpayers.”
The Congressional Budget Office reported that health reform will reduce the federal budget deficit by about $210 billion in the next decade and more than $1 trillion over the next 20 years.
“No legislation that Congress has passed in modern times will have such a dramatic effect on lowering the federal budget deficit than the health care legislation that was passed,” Baucus said. “That is not recognized and, of course, people have a hard time seeing that, but it’s a fact.”
At what price?
Some critics fear the Affordable Care Act will cost jobs.
The fact is that the national unemployment rate has gone down since health care reform became law. Nationwide, more than 1 million private-sector jobs have been created since the health care law was enacted and 243,000 have been in health care. The independent chief actuary at The Centers for Medicare and Medicaid Services and the Congressional Budget Office said the health care law strengthens the economy by lowering the rate of health care costs and reducing the deficit.
The Congressional Budget Office, the independent Joint Committee on Taxation and other economists agree that lower health care costs would free up resources for employers and result in higher wages for workers. Lower costs also mean more money to hire workers.
Before the law, Medicare was forecast to be bankrupt in seven years, according to a Senate hearing with U.S. Secretary of Health and Human Services Kathleen Sebelius earlier this month. According to the Centers for Medicare and Medicaid Services, the law extends the life of Medicare for 12 more years.
The major purpose of the law is to reduce health care costs, Baucus said. Americans spend about 53 percent more per person on health care than the next most expensive country and we’re not 53 percent per person healthier.
The United States spends $7,290 per person per year, or 16 percent of the Gross Domestic Product on health care. The next-closest is Norway, which spends $4,763 per person, accounting for only 8.9 percent of its GDP, according to the Organization for Economic Cooperation and Development.
“We can’t go on like that,” Baucus said.